The decision to go ahead with surgery was again a hard one, especially since the shoulder had been feeling better in the latter part of the summer. The factors that influenced me most were the poor blood supply to the cartlidge and the age of the injury led me to conclude that there was no chance for spontaneous healing. At the rate it was deteriorating, I would probably have had to give up archery in a couple of years. The operation gave hope that this could be averted, or at least delayed rather longer.
Photos taken during the operation show a badly
torn superior labrum (an unstable type 2 SLAP tear). This photo shows the
tear extending into the attachment of the biceps tendon. A 90-degree probe is
being used to examine the extent of the tear. The probe is pushed between the
biceps tendor (top left) and the humeral head (top right).
Compare the previous picture with a picture of a
or with the picture above of the stable anterior labrum. The probe is not
able to part the labrum and glenoid.
There was also a small radial tear of the anterior/inferior labrum shown on
the MRI scans. This photo of it shows it is not very extensive.
The axillary pouch was
moderately large, indicating looseness of the joint capsule.
One aspect of the shoulder problem that did not show up on the MRI or X-rays
was grade 3
of the humeral head, shown in this picture. This
is a wearing away of the sheath covering the bone, and is more common in
knees (it is sometimes referred to as ``runner's knee''). Grade 3
chondromalacia is nearly worn through to the bone. This discovery has made me
more positive that having the operation was the right thing to do. Reducing
the abnormal motion of the joint may prevent the rubbing that was damaging
The repair involves burring the bone of the shoulder capsule, causing it to
bleend, and then putting a couple of dissolvable bone anchors ($550 on the
itemised bill!) into the glenoid and suturing the sides of the labrum tear to
the anchors. The increased blood flow and burr damage to the bone provokes
the healing response, allowing the immobilised labrum to re-attach to the
glenoid. This photo shows the final result, with the blue translucent sutures
holding the tear together while it is probed.
As well as the SLAP repair, the surgeon performed an electrothermal capsulorraphy to tighten the loose joint capsule.
The first week, essentially no motion of the arm was allowed. After the first follow-up visit on 1st October, the surgeon said it was alright to type two-handed, so long as the hand rested on the keyboard or in my sling. Physiotherapy started at this time, and my physiotherapist was allowed to perform passive range of motion exercises up to 90 degrees of flexion and abduction, and 30 degrees external rotation. In the second week, she added scapular mobilisation exercises and some isometric resistance. I am currently just entering the active-assisted phase, where the arm is moved through the same range with a little muscle power and assistance from the other hand. After the second follow-up visit on the 15th of October, the doctor removed the range limitations and replaced them with ``as much as I can tolerate''. Just the day before I'd been reading an article about how redheads feel more pain, so I'm not sure how much that will be!
One unexpected consequence was short term weight loss; I lost 5lb in first week, and my weight seems to be staying down. I wouldn't recommend this as a way of dieting, though . The frustration factors were: I couldn't drive. I couldn't fly. No karate. No archery. No fishing. No skiing. I tried to go for short walks every day to stop it from getting too boring.
Update: after six weeks, I was able to stop using the sling. I am still in physiotherapy two days a week, partly due to concerns about adhesive capsulitis. My range of motion and strength in flexion are improving, but abduction is still very limited and painful. I have been able to go fishing a couple of times (the motion is mostly flexion), and eight weeks after the surgery, I caught a 12 pound chum salmon!
Update: after three months, I am back to skiing. My Telemark skills have improved considerably from not using the shoulder. I have also just convinced my doctor that I have sufficient range of motion and strength to return to flying. Flexion and extension are very good. Adduction and abduction are good. External rotation is still a little bit restricted, and I am also still in the process of re-building the shoulder muscle, so I am not drawing my own bow. I have been able to shoot a 20lb training bow. There is still a small sign of the adhesive capsulitis; the humeral head does not glide properly into the socket in full abduction.
Update: after seven months, I have finished physical therapy. I have just finished my first archery tournament of the year, and am quite pleased with the results. I have returned to karate as well, and have been skiing a bit too. A fall while skiing shortly after the last update had me very worried for a while, thinking I might have ripped the repair. It may have actually done some good, by breaking up scar tissue in the joint. I am still doing strengthening exercises; external rotation in that arm is much weaker than the other side. I have very close to full range of motion back.
Update: the archery in 2003 didn't go as well as I had hoped. There was still persistant pain in the joint from the chondromalacia, so I quit shooting early for the year. After some experimentation, I found that I can shoot lighter weight limbs without the same pain, so I have now bought some newer, faster, 36lb limbs and weaker arrows.